Early postpartum symptoms in puerperal psychosis

Department of Primary Care and General Practice, University of Birmingham, Birmingham, UK.
BJOG An International Journal of Obstetrics & Gynaecology (Impact Factor: 3.45). 03/2008; 115(3):348-53. DOI: 10.1111/j.1471-0528.2007.01563.x
Source: PubMed


To examine the nature of the earliest reported symptoms in women who develop a bipolar affective puerperal psychosis (PP).
A retrospective interview study.
Women were recruited for clinical and molecular genetic studies of PP from a national PP network, articles in the national press and referrals from UK specialist perinatal psychiatry services.
One hundred and twenty-seven women met the criteria for an episode of strictly defined bipolar affective PP developing within 4 weeks of childbirth.
Participants were interviewed using the Schedule for clinical assessment in neuropsychiatry and hospital records were reviewed. Lifetime and puerperal episode diagnoses were made according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) based on all the available information. During interview, participants were asked to describe the earliest symptoms they believed to be related to their illness onset. The day of onset for each symptom was recorded.
We present subjectively experienced emotional and behavioural changes occurring within 3 days of childbirth, reported by four or more women.
Seventy-three percent of women recalled experiencing an onset of symptoms by day 3. The most commonly recalled symptoms were feeling excited, elated or high (52%), not needing to sleep or not able to sleep (48%), feeling active or energetic (37%) and talking more or feeling very chatty (31%).
Hypomanic symptoms are particularly characteristic of the early postpartum in women who develop PP. These types of symptoms should be carefully monitored in individuals at high risk of PP episodes.

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Available from: Emma Robertson Blackmore, Jan 06, 2014
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    • "Today, 1–2 in every 1000 women experience psychotic or manic symptoms in the first 4 weeks after childbirth and are diagnosed with postnatal psychosis, also known as postpartum or puerperal psychosis (Austin & Highet 2011, American Psychiatric Association 2013, Essali et al. 2013). Postnatal psychosis is characterized by the rapid onset of hallucinations, delusions, confused thinking and mood swings and is a risk factor for maternal suicide and infanticide (Brockington 1996, Sit et al. 2006, Heron et al. 2008, Oates 2008, Doucet et al. 2009, Posmontier 2010, Oates & Cantwell 2011, Glover et al. 2014). It is treated with antipsychotic and mood stabilizers; however, admission is often required to prevent harm to the woman or to any other person, including the child (Doucet et al. 2009, Posmontier 2010). "
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    ABSTRACT: Aim: This study analysed historical healthcare records to investigate how women diagnosed with mania or psychosis and admitted to two mental health facilities in Australia following childbirth, were described in the late Victorian (1885 to 1895) and inter-war period (1925 to 1935). Background: Although historians have examined the history of mental health systems in Australia, there is no published scholarship that considers the healthcare records of these women. This was a unique opportunity to explore these documents. Design: An historical study examining healthcare records. The data collection occurred in 2012. Methods: Women admitted to mental health facilities with a diagnosis of psychosis or mania were identified in the admission registers found in the State Record Office of New South Wales and, if available, their healthcare record was transcribed verbatim. The records were imported into NVivo 10 for content analysis to determine the range and scope of information. A further textual analysis was conducted to see if the woman’s diagnosis was congruent with the outcome of her admission. Results/Findings: 155 cases were identified across the two periods. Although, demographic data and the description of the women on admission were remarkably similar, 17% of women were physically, rather than mentally, ill and died soon after admission. The findings demonstrate the importance of current practices such as taking a comprehensive healthcare assessment and the use of antibiotics and sanitary measures during labour and in the postnatal period. Conclusion: Historical investigations of healthcare records provide legitimacy for current healthcare practices.
    Full-text · Article · Aug 2015 · Journal of Advanced Nursing
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    • "The consequences could be traumatic and sometimes result in suicide and infanticide [14]. The majority of cases occur within the first few weeks [15] after childbirth, with a rapid onset of delusions, hallucinations, and impaired reality [16] [17]. The prognosis for PPP is favourable. "
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    ABSTRACT: The aim of the study was to describe Swedish psychiatrists’ experiences of involving the family in the treatment of women with postpartum psychosis. A qualitative design was used, and semistructured qualitative research interviews were conducted with nine psychiatrists from the south of Sweden. Data were analysed using qualitative content analysis. Four categories were found: the family as a resource , the family as coworkers , preparing the family for the future , and the family as a burden . The result showed that the psychiatrists considered the family to be a resource to which they devoted a great deal of care and effort. It was particularly important to involve the partner, informing about the course of the illness and the steps that need to be taken in the event of a relapse and reducing any guilt feelings. The psychiatrists instilled confidence and hope for a future of health and further child bearing. The family members’ limited understanding of the treatment may impede the involvement of the family. Conclusion of the study was that the goal for family involvement was to facilitate the women’s care and treatment. Further studies are needed to provide suggestions on how to develop family involvement in the care of women suffering from postpartum psychosis.
    Full-text · Article · Jan 2013
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    • "Postpartum depression refers to a non-psychotic depressive episode that often requires treatment and affects approximately 13% of mothers within 12 weeks of giving birth (O'Hara and Swain 1996). PP is more severe than postpartum depression, often requiring hospitalization, and is characterized by delusions, hallucinations, bizarre behavior, depression, mania, and mood lability that usually presents within the first 2 weeks postpartum (Heron et al. 2008; Sit et al. 2006). "
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    ABSTRACT: To explore the perceived support needs and preferences of women with postpartum psychosis and their partners. A multisite, exploratory, qualitative descriptive design was used. A purposive sample of nine mothers (Canada, n = 7, United States, n = 2) and eight fathers (Canada, n = 7, United States, n = 1) was obtained. Data were collected through one-on-one, in-depth, semistructured interviews. Inductive thematic analysis was used to explore the qualitative transcripts. Couples who experienced postpartum psychosis looked to health professionals to provide reassurance and information on the illness, its management, and prognosis. The quality of support and interactions with staff varied, and participants reported difficulty identifying and obtaining professional support upon discharge. All participants felt that support groups for postpartum illnesses would help to normalize the experience and dissipate feelings of isolation. Participants reported that informal support networks provided practical help but were limited or hindered recovery and management due to lack of knowledge of the illness. Despite feeling overwhelmed and isolated, fathers were reluctant to identify their own support needs and struggled to ask for help from professionals and their informal support network. These findings suggest that clinical interventions are needed to address the support needs and aid in the recovery of families affected by postpartum psychosis.
    Full-text · Article · Feb 2012 · Journal of Obstetric Gynecologic & Neonatal Nursing
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